Increased basal ganglia volumes in velo-cardio-facial syndrome (deletion 22q11.2).

BACKGROUND: This study evaluated differences in caudate volumes in subjects with velo-cardio-facial syndrome due to a 22q11.2 (22qDS) deletion. Because psychosis is observed in 30% of adult subjects with 22qDS, this neurogenetic disorder could represent a putative model for a genetically mediated subtype of schizophrenia.METHODS: Caudate volumes were measured on high-resolution magnetic resonance images in 30 children and adolescents with 22qDS and 30 gender- and age-matched normal comparison subjects.RESULTS: Caudate head volumes were increased in the 22qDS group independent of neuroleptic medications. Subjects with 22qDS also displayed an abnormal pattern of asymmetry in the anterior caudate, with left side greater than right.CONCLUSIONS: Alterations in the basal ganglia circuitry have been implicated in learning, cognitive, and behavioral problems in children and therefore could be involved in the expression of the neurobehavioral phenotype expressed by subjects with 22qDS. Abnormal caudate volume is a neurodevelopmental feature shared with schizophrenia, further establishing 22qDS as a potential neurodevelopmental model for this disorder.     

Prognostic Implications of Tumor Differentiation in Clinical T1N0 Gastric Adenocarcinoma

BackgroundCurrent guidelines recommend neoadjuvant chemotherapy in patients with locoregional gastric adenocarcinoma. Patients diagnosed with early stage gastric adenocarcinoma are usually managed with upfront surgical intervention. However, pathologic staging in a subset of these clinically staged patients identifies more advanced locoregional disease requiring adjuvant treatment. Therefore, identifying these patients prior to surgical intervention is critical to ensure employment of the appropriate treatment paradigm. The aim of the current study was to define patient characteristics associated with clinical understaging in early gastric cancer.MethodsUsing the National Cancer Database (2004–2014) we identified 3,892 individuals with clinical T1N0 gastric adenocarcinoma who underwent upfront definitive surgery, had negative surgical margins, and did not receive preoperative chemotherapy or radiotherapy. Patient characteristics were compared between those with pathologic stage T1N0 disease and those who were upstaged upon surgery.ResultsTwenty‐seven percent of clinical T1N0 gastric adenocarcinomas had a change in stage because of pathologically defined ≥T2 disease or positive lymph nodes. Individuals who were upstaged had a higher tumor grade compared with those with pathologic stage T1N0 disease. Specifically, 41.9% (530/1,264) of individuals with a poorly differentiated tumor were upstaged, compared with only 10.7% (70/656) with a well‐differentiated tumor. Approximately 75% of cases involved upstaging because of T misclassification. The highest percentage of upstaging was shown for tumors located at the fundus and body of the stomach.ConclusionUpstaging of clinical T1N0 gastric adenocarcinoma is characterized by higher tumor grade and is mostly a result of a change in T stage. These findings mandate thorough workup in order to identify patients with clinically staged T1N0 disease requiring preoperative chemotherapy.Implications for PracticeUpstaging of clinical T1N0 gastric adenocarcinoma is characterized by higher tumor grade and is mostly a result of a change in T stage. These findings mandate thorough workup in order to identify patients with clinically staged T1N0 disease requiring preoperative chemotherapy.     

CB2 cannabinoid receptor agonist enantiomers HU-433 and HU-308: An inverse relationship between binding affinity and biological potency

Activation of the CB2 receptor is apparently an endogenous protective mechanism. Thus, it restrains inflammation and protects the skeleton against age-related bone loss. However, the endogenous cannabinoids, as well as Δ⁹-tetrahydrocannabinol, the main plant psychoactive constituent, activate both cannabinoid receptors, CB1 and CB2. HU-308 was among the first synthetic, selective CB2 agonists. HU-308 is antiosteoporotic and antiinflammatory. Here we show that the HU-308 enantiomer, designated HU-433, is 3–4 orders of magnitude more potent in osteoblast proliferation and osteoclast differentiation culture systems, as well as in mouse models, for the rescue of ovariectomy-induced bone loss and ear inflammation. HU-433 retains the HU-308 specificity for CB2, as shown by its failure to bind to the CB1 cannabinoid receptor, and has no activity in CB2-deficient cells and animals. Surprisingly, the CB2 binding affinity of HU-433 in terms of [³H]CP55,940 displacement and its effect on [³⁵S]GTPγS accumulation is substantially lower compared with HU-308. A molecular-modeling analysis suggests that HU-433 and -308 have two different binding conformations within CB2, with one of them possibly responsible for the affinity difference, involving [³⁵S]GTPγS and cAMP synthesis. Hence, different ligands may have different orientations relative to the same binding site. This situation questions the usefulness of universal radioligands for comparative binding studies. Moreover, orientation-targeted ligands have promising potential for the pharmacological activation of distinct processes.The CB2 cannabinoid receptor functions as an endogenous protective entity (1). Thus, it is an important regulator of bone mass and inflammation. It represents a therapeutic target that avoids the undesired psychotropic effects caused by CB1 receptor activation. CB2 is expressed in osteoblasts, the bone-forming cells, and in osteoclasts, the bone-resorbing cells (2). Monocytes/macrophages, B cells, certain T-cell subtypes, and mast cells also express CB2 (3–7). In the skeleton, activation of CB2 favors bone formation over resorption, thus protecting the skeleton against age-related bone loss. Inflammatory responses are restrained by CB2 agonists in several instances such as hepatic ischemia-reperfusion injury (8), uveitis (9), and contact dermatitis (10). With their terpene and resorcinol-derived moieties, some synthetic CB2 agonists, such as HU-308 (10), JWH-133 (11), and HU-910 (12), structurally resemble the phytocannabinoids Δ⁹-tetrahydrocannabinol and cannabidiol. Other, non-phytocannabinoid-type agonists have been also reported (13). HU-308 was one of the first fully characterized, highly selective, and highly efficacious cannabinoid type-2 agonist (10). It has three chiral centers, namely, at carbon atoms in positions 3, 4, and 6 (Scheme 1). HU-308 has a 3R, 4S, 6S configuration; that of its enantiomer (HU-433) is 3S, 4R, 6R.Open in a separate windowScheme 1.Structures of HU-433 and -308.In most experiments, the optimal HU-308 mitogenic activity in osteoblasts, as well as its antiosteoclastogenic effect, was obtained by using concentrations in the nanomolar range (2, 14). Surprisingly, testing a new HU-308 batch, we noticed a 3- to 4-magnitude decrease in the dose that triggers optimal proliferative response in osteoblasts, reasoning that this preparation contained a significant amount of the HU-308 enantiomer, presumably responsible for the enhanced activity. We report here that this enantiomer, designated HU-433, was synthesized and compared with HU-308, and indeed showed markedly enhanced bone-anabolic and antiinflammatory activities, but inferior CB2 receptor binding affinity. Although both enantiomers seem to target the same binding pocket, two different orientations relative to the binding site are possible, leading to different behavior of the two enantiomers due to their different occupancy of these orientations. This observation appears to reflect a situation in which relatively small differences in possible binding conformations of the ligands within the receptor—referred to as poses—lead to significant diminution of receptor-binding properties and a marked increase in biological activity.     

A novel form of familial bidirectional ventricular tachycardia

We evaluated a family with 30 members, 3 of whom had incessant polymorphous and bidirectional ventricular tachycardia (VT) that was electrocardiographically similar to that described in other familial polymorphic VT series; the VT was unrelated to exercise and asymptomatic. More subtle, but morphologically similar, ventricular arrhythmias were detected in 3 other family members. Genes related to intracellular calcium transport were specifically excluded.     

Arachnoiditis ossificans of the cauda equina

A case of post-traumatic arachnoiditis ossificans of the cauda equina is reported. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equine compression. The pathophysiology and therapeutic strategy of this rare entity are still controversial.     

Multiple adaptive mechanisms to chronic liver disease revealed at early stages of liver carcinogenesis in the Mdr2-knockout mice

Molecular events preceding the development of hepatocellular carcinoma were studied in the Mdr2-knockout (Mdr2-KO) mice. These mice lack the liver-specific P-glycoprotein responsible for phosphatidylcholine transport across the canalicular membrane. Portal inflammation ensues at an early age followed by hepatocellular carcinoma development after the age of 1 year. Liver tissue samples of Mdr2-KO mice in the early and late precancerous stages of liver disease were subjected to histologic, biochemical, and gene expression profiling analysis. In an early stage, multiple protective mechanisms were found, including induction of many anti-inflammatory and antioxidant genes and increase of total antioxidant capacity of liver tissue. Despite stimulation of hepatocyte DNA replication, their mitotic activity was blocked at this stage. In the late stage of the disease, although the total antioxidant capacity of liver tissue of Mdr2-KO mice was normal, and inflammation was less prominent, many protective genes remained overexpressed. Increased mitotic activity of hepatocytes resulted in multiple dysplastic nodules, some of them being steatotic. Expression of many genes regulating lipid and phospholipid metabolism was distorted, including up-regulation of choline kinase A, a known oncogene. Many other oncogenes, including cyclin D1, Jun, and some Ras homologues, were up-regulated in Mdr2-KO mice at both stages of liver disease. However, we found no increase of Ras activation. Our data suggest that some of the adaptive mechanisms induced in the early stages of hepatic disease, which protect the liver from injury, could have an effect in hepatocarcinogenesis at later stages of the disease in this hepatocellular carcinoma model.     

An educational intervention for providers to promote bone health in high-risk older patients

OBJECTIVES: To design, implement, and assess an educational intervention for providers focused on osteoporosis screening and management in older patients with chronic obstructive pulmonary disease or asthma who have been prescribed prolonged courses of oral or high‐dose inhaled corticosteroids or both and are therefore at high risk for bone loss and fractures. DESIGN: One‐group pretest–posttest. SETTING: Academic outpatient pulmonary practice. PARTICIPANTS: Nineteen pulmonary specialists at an academic medical center. INTERVENTION: Educational theory and a needs assessment and attitude survey guided the development of a multicomponent educational intervention. MEASUREMENTS: Change in provider behavior was assessed by auditing the electronic medical records for adherence to osteoporosis management guidelines in high‐risk patients seen by participants at baseline and for 6 months after the educational intervention. Knowledge transfer and changes in attitude were assessed using pre‐ and posttests and surveys. RESULTS: A 19% increase in overall rate of adherence to osteoporosis management guidelines in high‐risk patients was observed: 45% before intervention to 64% after intervention (n=249 patients, P=.003). Postintervention surveys and test scores also showed statistically significant gains from baseline. CONCLUSION: An educational intervention improved adherence to osteoporosis management guidelines of academic pulmonary specialists. The results of this study provide evidence for the positive effect of a multimodal educational program in altering practice behaviors.